Individual
DR. DAVID BRENT PEMBERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
101 COWARDIN AVE, SUITE 303, RICHMOND, VA 23224-2078
(804) 233-6811
(804) 230-0980
Mailing address
101 COWARDIN AVE, SUITE 303, RICHMOND, VA 23224-2078
(804) 233-6811
(804) 230-0980
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401005552
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000762638
UNITED CONCORDIA
PA
01
—
001701144
UNITED CONCORDIA
PA
01
—
077683
ANTHEM
VA
01
—
165313
DORAL DENTAL
WI
01
—
172260
ANTHEM
VA
05
—
7815042
—
VA
Enumeration date
08/05/2007
Last updated
10/16/2013
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